Prescription drug monitoring programs (PDMPs) are a centerpiece of state efforts to confront the US epidemic of prescription opioid-related morbidity and mortality. However, evidence suggests their full potential has not been realized because of prescriber and pharmacist underuse. PDMPs have been implemented in 49 states to combat prescription drug abuse and improve patient safety, but because pharmacists have little guidance about how to integrate the PDMP into pharmacy practice, PDMPs have not their fulfilled their potential as a clinical decision tool. The long-term goal of this project is to redce opioid-related harms by improving skills and resources available to community pharmacists so they can effectively screen, communicate, and ultimately reduce unsafe opioid dispensing. In response to PA-04-002 (Advancing Patient Safety Implementation through Safe Medication Use), the objective of this study is to develop a community pharmacy PDMP toolkit for identifying patients for whom dispensing an opioid prescription presents a safety risk, communicating with patients at the point of care, and coordinating with the primary prescriber to maximize patient safety in the use of opioid analgesics. Information in the toolkit will enable community pharmacists to integrate the PDMP into their workflow, identify patients at risk for opioid-related harms, approach patients with concerns, and coordinate care with their primary prescribers. The central hypothesis is that enhancing the integration of PDMPs in community pharmacy practice will lead to increased PDMP use and ultimately safer opioid dispensing. This hypothesis will be tested through three specific aims: The first aim of this study is to develop th PDMP toolkit, including policies and procedures for how community pharmacists can effectively use PDMP at the point of care to increase patient safety and reduce opioid-related harms. Focus groups of pharmacists, prescribers, and patients will inform development of the toolkit. The second aim is to implement the PDMP toolkit in six community pharmacies and evaluate the impact of the toolkit on pharmacists' knowledge, attitudes, self-efficacy, and perceptions of opioid dispensing safety. The third aim is to evaluate whether implementation of the PDMP toolkit results in safer opioid use. This project is innovative because it challenges pharmacists t elevate their clinical practice with the goal of improving patient safety and reducing opioid- related harms. Upon completion, the developed PDMP toolkit will be immediately available and usable in many community pharmacy settings.